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General NPI Number Information
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NPI Number | 1902129562
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Entity Type | Organization
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Legal Business Name | AASPEN VILLAGE CARE
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 7633 KICKAPOO TRL
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3339
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Country | US
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Telephone | 760-228-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 7633 KICKAPOO TRL
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3339
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Country | US
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Telephone | 760-228-2729
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. MUSHTAQ KHAN
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Credential | M.D.
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Telephone | 310-383-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 366423788
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License Number State | CA
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